Dean (above) has studied fatigue in patients with cancer since the late 1980s.

“Sleep is an absolute basic human necessity, like eating, drinking and breathing, but is often overlooked and not assessed unless the lack of it is determined to be severe.”

Grace Dean, PhD, RN, assistant professor of nursing

University at Buffalo

BUFFALO, N.Y. — It is estimated that anywhere from 50 to
80 percent of persons diagnosed with lung cancer experience severe
insomnia that may persist for an average of eight years after the
initial diagnosis.

Sleeplessness in lung cancer patients is related to a blend of
pre-existing habits and conditions, as well as treatments specific
to lung cancer, including a history of smoking, pre-existing
chronic obstructive pulmonary disease (COPD) and the effects of
lung cancer surgery, specifically partial lung removal and the
postoperative radiotherapy that may follow. These treatments and
conditions can result in anxiety, pain, cough and impaired
breathing that make it difficult to fall asleep and to stay
asleep.

To date, little research exists on strategies to reduce insomnia
in lung cancer patients.

But Grace Dean, PhD, RN, assistant professor of nursing at the
University at Buffalo who has studied fatigue in patients with
cancer beginning in the late 1980s, is hoping to find ways to help
patients solve this problem — and not always with sleeping
medication.

Dean is the primary investigator on a $300,000 National
Institutes of Health (NIH) grant to study cognitive behavior
therapy techniques for lung cancer survivors who suffer from
sleeplessness related to their diagnosis. The study,
“Translating Cognitive Behavior Therapy-Insomnia (CBT-I) for
Lung Cancer into Practice: A randomized controlled trial
(RCT),” will run from September 2013 through August 2015.

Dean says the importance of sleep to health and well-being
cannot be underestimated.

“Sleep is an absolute basic human necessity, like eating,
drinking and breathing, but is often overlooked and not assessed
unless the lack of it is determined to be severe,” she says.
“Chronic sleep deficiency leads to increased risks for heart
disease, kidney disease, hypertension, obesity, diabetes and
depression.”

Preliminary work by Dean and her co-investigators leading up to
the current grant suggests that lung cancer patients who have
chronic insomnia may benefit from cognitive behavior therapy.

“We have designed a group intervention using cognitive
behavior therapy for insomnia techniques to be delivered by nurses
and that we will test on patients who are at least six weeks postop
from Stage I/II, non-small cell lung cancer surgery,” she
says. “If the intervention is significantly better than the
control, we will pursue funding to teach this intervention to
bedside nurses in the clinical setting.”

CBT-I, says Dean, uses the following techniques to improve
sleep:

Sleep hygiene — establishing a bedtime routine to wind
down for sleep by limiting stimulants, for example

Although all of the above techniques are essential to CBT-I,
Dean says the two most important are sleep restriction and stimulus
control.

She points out that CBT-I results in clinically significant
improvements in insomnia symptoms without the negative effects
commonly reported with some hypnotic (sleeping) medications, such
as slowed respirations in patients who already may be dealing with
oxygen deficiency.

“Studies show that patients and physicians are more likely
to use hypnotics as the first line of treatment for insomnia
symptoms,” she says. “Despite the effectiveness of
CBT-I and the need for this therapy, CBT-I is not clinically
accessible for most cancer patients.”

Why nurses?

Dean says nurses are uniquely positioned to deliver CBT-I for a
variety of reasons. They have access to patients and, as members of
the most trusted of 21 professions according to Gallup polls since
1999, patients are positively influenced by them.

“Indeed, nurses have received the highest ranking every
year except in 2001, when fire fighters received top honors,”
she says. “Furthermore, for some individuals, having a nurse
deliver the therapy is less stigmatizing than seeing a psychologist
or psychiatrist, no matter the reason.”

Dean’s co-investigators on the grant are Suzanne
Dickerson, DNS, RN, and Carla Jungquist, PhD, RN, from the UB
School of Nursing; Lynn Steinbrenner, MD, from the Veterans
Administration, Western New York Medical Center; Joseph Lucke, PhD,
from UB’s Research Institute on Addictions; Nadine Fisher,
EdD, from the UB Department of Rehabilitation Science; and Samjot
Dhillon, MD; Hongbin Chen, MD; and Elizabeth Dexter, MD, from
Roswell Park Cancer Institute.

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